Montreat Youth Conference Registration Form

"*" indicates required fields

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This field is for validation purposes and should be left unchanged.

Youth Name*

First Last

Grade Completed as of June 2026*

Gender*

Youth' Cell Phone*

Youth' Email*

Home Church Name*

Leader's Name*

First Last

Leader's Email*

Leader's Phone #*

Parent or Guardian's Name*

First Last

Parent or Guardian's Cell Phone*

Parent or Guardian's Email*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact*

First Last

Emergency Contact Cell Phone*

Allergies*

Health History (please include any prescribed medications and instructions in Savannah Presbytery leaders are to administer)*

Month/Year of last tetanus shot*

Insurance Company*

Insurance Member ID

Insurance Group or Policy Number

Insurance Policy Holder Name

First Last

The undersigned does hereby give permission for my youth: (“Participant”), to attend and participate in events sponsored by Savannah Presbytery.

Parent/Guardian please type your youth's name below to indicate your consent.*

First Last

Payment Options*

I will pay the full $650 Now

I will pay the required $350 Deposit now

a 2% + $.30 fee will be added to your total

Total Amount Due Today

a 2% + $.30 fee will be added to your total

Balance of $300 due by March 6, 2026

Payment*